Clinical characteristics of mirror syndrome: a retrospective study of 16 cases

Chen, Ruiyun; Liu, Min; Yan, Jianying; Chen, Fengyi; Han, Qing; Zheng, Lin; Luo, Jinying; Chen, Lichun; Liu, Hongfei; Yu, Lu

doi:10.1080/01443615.2020.1718621

Cited by 11 publications

(11 citation statements)

References 8 publications

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“…This overlap between MS and preeclampsia can easily lead to misdiagnosis. However, consistent with previously reported cases of MS with maternal hemodilution [ 2 , 3 , 12 , 13 ], our laboratory findings showed that the levels of hemoglobin, hematocrit, platelets and serum albumin were significantly lower in the MS group than in the non-MS group. Regardless of the fetal and placental causes, the hemodilution observed in cases of MS compared with typical hemoconcentration of preeclampsia may be considered in the differential diagnosis of these two diseases.…”

Section: Discussionsupporting

confidence: 93%

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Clinical characteristics and risk factors of mirror syndrome: a retrospective case-control study

Han

Chen

Wang

et al. 2021

BMC Pregnancy Childbirth

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Background Mirror syndrome (MS) is a rare obstetric disorder complicated with high maternal morbidity and fetal mortality. MS is often misdiagnosed or underdiagnosed due to the low incidence and lack of awareness of its diverse features. This study aimed to summarise the etiology, clinical characteristics, and risk factors of MS among mothers with fetal hydrops. Methods This retrospective case-control study included 37 pregnant women with fetal hydrops in the second and third trimesters from 58,428 deliveries performed at the Third Affiliated Hospital of Sun Yat-Sen University between January 2012 and December 2020. Cases were categorized as MS and non-MS according to the presence or absence of maternal mirroring symptoms. Binary logistic regression was performed for analysis. Results Fourteen women developed MS with an overall incidence of 0.024% (14/58,428) and 37.8% (14/37) in the fetal hydrops cases. Among the 11 MS cases with known associated etiologies, seven had alpha thalassemia major. Onset of fetal hydrops was later (27.8 vs. 23.0 weeks) and the rate of placental thickening was higher (85.7% vs. 34.8%) in the MS group than in the non-MS group (P < 0.05). Regarding maternal characteristics, the MS group had higher maternal morbidity (85.7% vs. 8.7%), more weight gain (9.0 vs. 5.5 kg), higher rates of hypertension (35.7 vs. 0%) and proteinuria (64.3% vs. 4.3%), and lower levels of hemoglobin (88 vs. 105 g/L) and serum albumin (25.8 vs. 35.0 g/L) than the non-MS group (P < 0.05). Logistic regression analysis showed that onset of fetal hydrops at ≥24 weeks and placental thickening were associated with the risk of MS among fetal hydrops cases (OR 15.83, 95% CI 1.56–160.10 and OR 8.63, 95% CI 1.29–57.72, respectively). Conclusions MS is relatively common among fetal hydrops cases in the late second and third trimesters, and alpha thalassemia major is the main etiology for fetal hydrops and also MS in this population. Complicated with high maternal morbidity, the key maternal features of MS include more weight gain, hemodilution, and hypertension. Among those with fetal hydrops, the onset time of ≥24 weeks and placental thickening are risk factors for MS.

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Section: Discussionsupporting

confidence: 93%

“…The prognosis of hydropic fetuses is generally poor and depends on the etiology and antenatal therapy [ 2 , 3 , 13 ]. In our study, the causes of hydrops were identified prenatally in 67.6% (25/37) of patients, and the most common etiology was alpha thalassemia major (17/37).…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics and risk factors of mirror syndrome: a retrospective case-control study

Han

Chen

Wang

et al. 2021

BMC Pregnancy Childbirth

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“…Despite recent advances in ultrasound and genetics, its pathology and etiology have yet to be determined. A variety of reasons leading to non-immune hydrops are described, such as chromosomal abnormalities, infection, fetal arrhythmias, and structural abnormalities (aneurysm of Galen's vein, sacrococcygeal teratoma) [4]. There are still many cases where the etiology of fetal hydrops/mirror syndrome has not been clarified.…”

Section: Discussionmentioning

confidence: 99%

“…We noticed that she did not attend several appointments from her antenatal notes, including her second-trimester anomaly scan. Nevertheless, she underwent amniocentesis in a different unit at 16 weeks of gestation for fetal hydrops, according to local guidelines [4]. Molecular karyotyping (array Comparative Genome Hybridization-CGH) was carried out, using SurePrint G3 CGH ISCA v2 SNP-Microarray, 4 × 180 K (Agilent technologies), and showed a normal result.…”

Section: Case Presentationmentioning

confidence: 99%

Fatal Association of Mirror and Eisenmenger Syndrome during the COVID-19 Pandemic

et al. 2021

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Mirror syndrome (MS) or Ballantyne’s syndrome is a rare maternal condition that can be life-threatening for both mother and fetus. The condition is characterized by maternal signs and symptoms similar to those seen in preeclampsia in the setting of fetal hydrops. Despite recent advances in the field of maternal-fetal medicine, the etiopathogenesis of MS remains elusive. For patients and doctors, the COVID-19 pandemic has become an extra hurdle to overcome. The following case illustrates how patients’ non-compliance associated with mirror syndrome and SARS-CoV-2 infection led to the tragic end of a 19-year-old patient. Therefore, knowledge of the signs and symptoms of mirror syndrome should always be part of the armamentarium of every obstetrician.

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“…En un hospital general de referencia en China se informó una incidencia de 0,01% 3 . El SE ha sido informado hasta en el 23% de las gestaciones donde se evidencia hydrops fetalis 4 .…”

Section: Introductionunclassified

Síndrome en espejo con miocardiopatía no compactada en la madre y el feto. Reporte de caso

Velásquez-Penagos

Flórez-Ríos

Muñoz-Ortiz

et al. 2021

Rev. Colomb. Obstet. Ginecol.

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Objetivo: reportar el caso de una gestante con síndrome en espejo asociada a miocardiopatía no compactada, tanto en la madre como el feto, en los que el tratamiento médico antenatal en la madre llevó a un resultado materno perinatal favorable. Presentación del caso: se describe el caso de una primigestante de 16 años, con 33 semanas de embarazo, remitida desde una institución de primer nivel de atención a una institución privada de cuarto nivel en la ciudad de Medellín, Colombia, por presentar feto con hidropesía en ultrasonido obstétrico de control. Durante la hospitalización, la paciente presentó signos clínicos y ecocardiográficos de falla cardiaca (disnea, edema e hipoxemia), a la vez que se confirmó el diagnóstico de Hydrops fetalis (síndrome en espejo). Se instauró tratamiento diurético con furosemida en la madre, logrando mejoría del cuadro materno y del edema fetal. En el puerperio mediato hospitalario se confirmaron la presencia de miocardiopatía no compactada en la resonancia magnética nuclear cardiaca, tanto de la madre como del recién nacido. Ambos egresaron en adecuadas condiciones y fueron vinculados al programa de seguimiento cardiovascular: falla cardiaca y de cardiopatía congénitas, respectivamente. Conclusión: se presenta un caso de síndrome en espejo asociado a miocardiopatía no compactada materna y fetal. Es limitado el número de reportes de síndrome en espejo por anomalías cardiacas (maternas y fetales) y pobre la descripción de los tratamientos realizados que surgen como temas a investigar. Sería importante considerar el diagnóstico de MNC en fetos con hidropesía no asociados a isoinmunización y con disfunción cardiaca, así como su atención por equipos multidisciplinarios.

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Clinical characteristics of mirror syndrome: a retrospective study of 16 cases

Cited by 11 publications

References 8 publications

Clinical characteristics and risk factors of mirror syndrome: a retrospective case-control study

Clinical characteristics and risk factors of mirror syndrome: a retrospective case-control study

Fatal Association of Mirror and Eisenmenger Syndrome during the COVID-19 Pandemic

Síndrome en espejo con miocardiopatía no compactada en la madre y el feto. Reporte de caso

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